Pain/MSK Flashcards
NSAID
Name
Diclofenac
NSAID
Mechanism of action
Inhibits prostaglandin synthesis via COX and modulates arachidonic acid release/uptake
NSAID
Indications
Pain, RA, osteoarthrosis, LBP, migraines, MSK acute issues, AS, acute gout
NSAID
Contraindications
PUD/gastric pain, CHD, organ failure, last trimester
NSAID
Side effects
Vertigo, N&V, diarrhoea, dyspepsia, elevated AST, rash, fluid retention
NSAID
Interactions
Chemotherapy drugs, methotrexate, renal impairment, warfarin
NSAID
Prescription advice
Take with food, consider gastroprotection >60/PUD
Compound Opioids
Name
Cocodamol, co-dydramol
Cocodamol
Mechanism of action
Activated by CYP450 to morphine, agonises opioid mu-pain receptors
Cocodamol
Indications
Mild-moderate pain
Cocodamol
Contraindications
Respiratory disease, renal/hepatic impairment
Cocodamol
Side effects
Nausea, constipation, drowsiness, toxic (hepatotoxic pcm/neuro-resp from opioid)
Cocodamol
Interactions
Avoid with other sedatives (antipsychotic, benzos, TCAs)
Strong Opioids
Name
Morphine, Oxycodone
Morphine
Mechanism of Action
Activates mu-opioid receptors to relieve pain, reduces response to hypercapnia/hypoxia
Morphine
Indications
Acute severe pain, chronic pain, end of life breathlessness
Morphine
Contraindications
Resp failure, hepatic/renal impairment, biliary colic (sphincter of oddi spasm)/pancreatic issues
Morphine
Side effects
Resp depression, neuro depression, can activate CTZ, pupillary constriction, increased smooth muscle tone, urticarial
Morphine
Interactions
Other sedative meds
Non-opioid analgesic
Paracetamol
Mechanism of action
Weak COX inhibitor reduces fever due to hypothalamic interaction, otherwise poorly understood
Paracetamol
Indications
First line analgesic, anti-pyrexial
Paracetamol
Contraindications
Chronic ETOH XS (raised NAPQI), reduced glutathione stores (malnourished, underweight)
Paracetamol
Side effects
Hepatotoxic
Paracetamol
Interactions
CYP inducers increase risk of toxicity (phenytoin, carbamazepin)
Xanthine oxidase inhibitors
Allopurinol
Mechanism of action
Prevent metabolism of xanthine (from purines) to uric acid, lowering plasma concentration and reducing risk of joint precipitation
Allopurinol
Indications
Prevention of gout, some renal stones, hyperuricaemia, tumour lysis syndrome (chemo)
Allopurinol
Contraindications
Acute attacks of gout, recurrent rash/hypersensitivity
Allopurinol
Side effects
Rash, stevens-johnson syndrome, toxic epidermal necrolysis, drug hypersensitivity syndrome
Allopurinol
Interactions
Drugs that req xanthine oxidase for metabolism (mercaptopurine, azathioprine)
